favv/ 

IIlTtl  c^S 


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FOREWORD. 


In  publishing  the  report  of  the  Special  Narcotic  Committee  the 
department  does  not  vouch  for  the  accuracy  of  the  figures  given  nor 
assume  finality  for  the  conclusions  arrived  at.  A careful  reading  of 
the  report  will  make  clear  the  reasons  for  this  statement.  Complete 
and  accurate  statistics  of  the  extent  of  drug  addiction  have  never 
been  compiled  and  are  not  now  available.  In  vieAV  of  the  scattered 
sources  of  information  and  the  fragmentary  statistics  secured,  the 
report  of  the  committee  probably  presents  as  comprehensive  a survey 
as  is  possible  under  the  circumstances  of  the  problem  from  the 
humanitarian  as  well  as  from  the  administrative  viewpoint. 

The  importance  of  securing  accurate  data  regarding  the  extent  and 
growth  of  the  traffic  in  narcotic  drugs  is  coming  to  be  more  keenly 
apjDreciated  by  all  authorities  and  in  the  near  future  it  is  hoped 
that  far  more  complete  data  Avill  be  made  accessible  to  iuA’estigators. 
This  report  is  presented  to  the  public  in  the  hope  that  it  will  enlist 
the  interest  and  cooperation  of  all  official  and  social  agencies  in. 
working  out  the  best  program  for  effecth^e  administration  of  the 
antinarcotic  laws  and  for  the  rebuilding  of  those  unfortunate  persons 
afflicted  with  the  narcotic  habit.  To  the  end  that  our  man  power 
may  be  properly  protected  from  this  growing  evil,  all  interested 
individuals  and  organizations  are  urged  to  furnish  information 
regarding  unsatisfactory  conditions  in  their  respective  communities 
and  to  submit  suggestions  for  the  better  enforcement  of  these  laAvs. 

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REPORT  OF  SPECIAL  NARCOTIC  COMMITTEE. 


Washington,  D.  C.,  April  15, 1919. 
The  Secretary  of  the  Treasury 

(Through  the  Commissioner  of  Internal  Revenue). 

Sir:  The  special  committee  appointed  by  your  predecessor  on 
March  25,  1918,  to  investigate  the  traffic  in  narcotic  drugs  has  com- 
pleted its  work  and  the  findings  thereof  are  embodied  in  the  following 
report  which  the  undersigned  have  the  honor  of  submitting  herewith. 
The  committee’s  investigations  have  been  as  thorough  and  extensive 
as  possible  with  the  facilities  at  hand  and  the  time  allotted  to  the 
work,  and  it  is  thought  that  the  data  herein  presented  convey  with  a 
fair  degree  of  accuracy  the  conditions  of  the  traffic  in  these  drugs  pre- 
vailing at  the  present  time. 

As  not  all  narcotic  drugs  are  habit  forming  or  of  importance  in 
the  sense  understood  b}^  the  committee,  and  as  some  of  the  habit-form- 
ing drugs  commonly  spoken  of  by  the  laity  as  narcotics  are  not  nar- 
cotics in  a medical  sense,  the  committee  has  limited  its  investigations 
to  the  traffic  in  opium,  its  preparations  and  habit-forming  alkaloids, 
and  coca  leaves,  their  preparations  and  habit-forming  alkaloids. 
These  are  the  drugs  which  are  definitely  covered  by  the  Harrison  Act 
and  are  most  pernicious  from  the  standpoint  of  habit  formation.  The 
nature  and  scope  of  the  committee’s  activities  are  definitely  stated  in 
the  outline  which  was  drawn  up  at  the  beginning  of  the  committee’s 
labors,  a copy  of  which  was  submitted  to  your  predecessor. 

For  the  purpose  of  securing  information  relative  to  the  different 
phases  of  this  traffic,  as  described  in  the  above-mentioned  outline,  the 
committee  has  used  every  means  at  hand.  Certain  data  were  obtained 
through  the  efforts  of  individual  members  of  the  committee.  Other 
information  was  secured  through  questionnaires  addressed  to  indi- 
viduals or  institutions  likely  to  be  in  possession  of  the  same,  and  by 
consultation  with  individuals  interested  in  the  problem  of  drug  addic- 
tion. Still  other  information  was  secured  through  the  efforts  of  the 
internal-revenue  agents.  All  information  thus  obtained  was  care- 
fully weighed  and  that  portion  which,  in  the  opinion  of  the  com- 
mittee, appeared  to  be  of  value  has  been  used  as  the  basis  of  this 
report. 

In  further  compliance  with  the  request  of  your  predecessor,  the 
recommendations  of  the  committee  for  changes  with  a view  to  improv- 
es) 


6 


ing  the  present  laws  and  regulations  governing  the  sale  and  use  of 
these  drugs  have  been  appended.  These  recommendations  are  based 
on  the  conditions  set  forth  in  this  report  and  are,  therefore,  thought 
to  be  particularly  pertinent. 

CO:^nvtERC'R  IN  NARCOTIC  DTJTJC.8. 


The  extent  of  the  commerce  in  narcotic  drugs  in  the  United  States 
can  not  be  accurately  estimated  because  of  the  fact  that  up  until  the 
present  time  the  laws  and  regulations  governing  their  sale,  and  use 
did  not  make  provisions  for  tracing  these  drugs  from  the  importer 
to  the  ultimate  consumer.  Some  idea  of  the  magnitude  and  ramifi- 
cations of  this  traffic  may,  however,  be  obtained  from  the  following 
table : 

Reffistratwns  under  the  Harrison  Narcotic  Law,  year  ended  Juno  30,  1918. 


Phy-sicians 125,  005 

Wholesale  dealers 831 

Dentists 42,  240 

Manufacturers 888 

Veterinarians 10,399 

Importers 76 


Hospitals,  etc 3, 799 

Educational 13S 

Retail  dealers 48, 196 

Miscellaneous 258 


Total 233,491 


Neither  can  the  value  of  this  commerce  be  accurately  estimated,  as 
the  crude  drugs  are  in  greater  part  manufactured  into  the  more 
costly  medicinal  preparations  and  alkaloids.  A minimum  estimate 
can,  however,  be  arrived  at  by  computing  their  value  on  the  basis  of 
the  retail  price  of  the  crude  products.  Thus,  the  average  yearly  con- 
sumption of  opium  for  the.  period  1910  to  1915  was  491,013  pounds. 
At  the  present  retail  price  of  $40  per  pound,  the  total  value  would- 
be  $18,841,720.  The  average  yearly  consumption  of  coca  leaves  for 
the  same  period  was  1,048,250  pounds.  At  the  present  retail  price  of 
$1  per  pound  the  total  value  would  be  $1,048,250.  The  grand  total 
would,  therefore,  represent  a value  of  apf»roximately  $20,000,000. 

From  the  information  at  hand,  it  is  concluded  that  the  larger  part 
of  these  drugs  pass  directly  from  the  hands  of  the  importer  to  those 
of  the  manufacturer,  where  they  become  a part  of  medicinal  jirepara- 
tions,  or  are  manufactured  into  alkaloids.  The  following  data  com- 
piled by  the  Bureau  of  the  Census  give  a fair  idea  of  the  extent  of 
these  operations  in  1914,  except  that  they  do  not  shov/  the  total  quan- 
tities of  alkaloids  produced. 

Of  4,092  manufacturers  making  patent  and  proprietary  medicines 
and  compounds  and  druggists’  preparations,  382  . reported  the  use 
of  opium  in  their  preparations,  300  I’eported  the  use  of  morphine  or 
its  derivatives,  138  reported  the  use  of  heroin,  142  reported  the  use 
of  diacetyl  morphine  (heroin),  and  136  reported  the  use.  of  cocaine 
or  its  derivatives — a total  of  1,098.  The  quantities  of  these  materials 
used  are  as  follows: 


'Narcotics  used  'by  manufacturers  during  19H. 


Opium 

Morphine,  or  derivative. 

Heroin 

Diacetyl  morphine 

Cocaine,  or  derivative- 


pounds 118, 282 

-ounces 316, 130 

do 13, 039 

- do 23, 859 

do 414,  255 


A very  considerable  quantity  of  these  drugs,  however,  is  secured  by 
the  wholesaler,  who  disposes  of  them  to  the  retailer  (principally 
druggists,  physicians,  dentists,  and  veterinarians,  although  they  are 
also  handled  in  the  form  of  exempt  preparations  and  proprietary 
remedies  bj^  grocers  and  department  stores),  and  eventually  they 
reach  the  consumer  through  these  channels. 

The  foregoing  statements  applj"  only  to  the  legitimate  traffic  in 
these  drugs.  In  addition,  there  is  the  so-called  “ underground  ” traffic, 
which  is  estimated  to  be  equal  in  magnitude  to  that  carried  on  through 
legitimate  channels.  This  trade  is  in  the  hands  of  the  so-called  “ dope 
peddlers,”  who  appear  to  have  a national  oi’ganizatian  for  procuring 
and  disposing  of  their  supplies.  For  the  most  part,  it  is  thought  that 
they  obtain  their  supplies  by  smuggling  them  from  Mexico  or  Canada, 
although  smaller  quantities  of  these  drugs  are  obtained  from  un- 
scrupulous dealers  in  this  country  or  by  theft.  Smuggling  is  also 
practiced  to  a considerable  extent  on  the  Atlantic  and  Pacific  coasts, 
where  the  drugs  arrive  on  ships  hailing  from  Europe  and  the  Orient. 
That  considerable  quantities  of  these  smuggled  drugs  are  exported 
from  this  country  for  the  purpose  of  reentry  through  illicit  channels 
appears  to  be  indicated  by  the  following  data  showing  the  increase  in 
the  exportation  of  opium,  morphine,  and  cocaine  to  Canada  in  recent 
years : 


Imports  of  opium  ami  morphine  into  Canada  from  all  sources,  and  from  the 
United  States,  years  ended  Mar.  31,  1013-1918.^ 


Description. 

1913 

1914 

1915 

1916 

1917 

1918 

Total  imports; 

Crude  opium .pounds  - . 

Powdered  opium do  — 

Morphine ounces . . 

From  the  United  States: 

Crude  opium pounds. . 

5,117 

301 

2,035 

917 

116 

5 

4,436 
287 
4, 487 

904 

157 

207 

7,284 

267 

259 

1,823 

14 

59 

1,741 
170 
15, 495 

1,351 

15, 423 
6.59 
52, 215 

2,413 
62 
16, 496 

12,471 

51 

27, 520 

Morphine. . .*. ounces . . 

12, 393 

* 9, 838 

> Data  obtained  from  “XJnrevised  monthly  statements  of  imports  for  consumption  and  exports  of  tlio 
Dominion  of  Canada,”  compiled  by  the  customs  department,  Ottawa. 

• Computed  on  the  basis  of  the  importation  of  17,682  ounces  at  a preferred  tariff. 


This  illegitimate  traffic  has  developed  to  enormous  proportions  in 
recent  years  and  is  a serious  menace  at  the  present  time.  It  is  through 
these  channels  that  the  addict  of  the  underworld  now  secures  the  bulk 
of  his  supplies. 


OPIUM  AND  COCAINE  CONSUMED. 


The  consumption  of  narcotic  drugs  in  this  country  has  steadily  in- 
creased from  the  date  of  their  introduction.  This  is  strildngly 
brought  out  by  the  following  table. 


Average  annual  consunipHon  of  opium,  hy  decades,  for  the  period  1860  to  1015, 

inclusive. 


Dectide. 

Population. 

Average 
amount  ot 
opium  (9  per 
cent  mor- 
phine) en- 
tered for 
consumption 
annually. 

Average 
amount  of 
opium 
(smoking) 
entered  for 
consumption 
annually. 

Average 
amount  of 
opium  (both 
kinds)  en- 
tered for 
consumption 
annually. 

1860-1869 

31.000. 000 

33.000. 000 

50. 000.  000 

63.000. 000 

76.000. 000 

92. 000.  000 

Founds. 
110,305 
192, 002 
328, 392 
513, 070 
480,009 
471,013 

Pounds. 
24,7ft> 
48,701 
85,988 
92,463 
148, 168 

Pounds. 
135,110 
240,704 
444,380 
605, 533 
628, 177 

1870-1879 

1880-1889 

1890-1899 

1900  1909 

1910-1915 

This  table  shows  further  that,  whereas  the  population  of  the  XTnited 
States  was  two  and  a half  times  as  great  in  1900  as  in  1860,  the 
amount  of  opium  entered  for  consumption  annually  was  approxi- 
inatelj'  five  times  as  great.  This  is  particularh'  significant  in  view’  of 
the  fact  that  the  use  of  large  amounts  of  synthetic  somnifacients,  such 
as  chloral  hydrate,  sulphonal,  trional,  veronal,  etc.,  during  the  last 
25  years  would  be  expected  to  have  diminished  to  a great  extent  the 
use  of  opium  or  its  alkaloids  for  legitimate  medical  purposes.  This 
would  indicate  that  the  use  of  opium  and  its  alkaloids  for  other  than 
legitimate  medical  purposes  has  constantly  increased. 

Cocaine  w'as  fu-st  introduced  into  this  country  about  30  years  ago, 
and  at  the  present  time  the  annual  consumption  of  coca  leaves,  from 
which  cocaine  is  obtained,  amounts  to  1,048,250  pounds.  This  condi- 
tion prevails  in  spite  of  the  fact  that  there  are  now’  in  use  a dozen  or 
more  synthetic  substitutes  which  w’ould  naturally  be  expected  to 
diminish  the  amount  of  cocaine  used  in  proportion  to  the  extent  to 
Avhich  these  substitutes  are  employed.  This  fact  shows  that  there 
is  undoubtedly  a large  quantity  of  cocaine  used  for  illegitimate  pur- 
poses, namely,  for  the  satisfaction  of  addiction. 


Imports  C)f  coca,  leaves, .cocaine,  egonine,  and  satis  and  derirutives  into  the  United 
States,  fiscal  years  ended  June  30.  1011-1016. 


Description. 

1911 

1912 

1913 

1914 

1915 

1916 

Coca  leaves pounds. . 

Cocaine,  egonine,  salts,  and 
derivatives ounces. . 

1,226.771 

4,031 

l,I79.5fO 

2,004 

1,175,780 

3,715 

711,564 

3,290 

1,048,312 

179 

947,537 

4,275 

9 


It  has  been  stated  that  about  90  per  cent  of  the  amount  of  these 
drugs  entered  for  consumption  is  used  for  other  than  medical  pur- 
poses. While  this  statement  is  probably  extreme,  a comparison  of 
the  per  capita  consumption  in  this  country  with  that  of  other  coun- 
tries indicates  that  this  country  consumes  from  thirteen  to  seventy- 
two  times  as  much  opium  per  capita  as  is  consumed  by  other  coun- 
tries, the  records  of  which  were  available.  The  following  table 
brings  this  out  more  clearly : 


Per  capita  consumption  of  opium  hy  United  States  and  certain  foreign  countries. 


Country. 

Population.! 

Total  annual 
consumption. 

Consump- 
tion per 
capita. 

■16.000,000 

33.000. 000 

60.000. 000 
5,  ,600, 000 

40,000,000 

6.000,000 

Pounds. 

3,000-4,000 

6.000 

17,000 

2,000 

Grains. 

1 

2 

2^ 

3 

Franco. 

17,000 

3,000 

470,000 

Sh 

92,000,000 

36 

' The  population  is  that  given  for  1910. 


As  the  average  dose  of  opium  is  1 grain,  the  amount  consumed  in 
the  United  States  per  annum  is  sufficient  to  furnish  36  doses  for  every 
man,  woman,  and  child.  When  it  is  considered  that  the  greater  por- 
tion of  our  citizens  do  not  take  a single  dose  of  opium  year  after  year, 
it  is  manifest  that  this  enormous  per  capita  consumption  is  the  result 
of  its  use  for  the  satisfaction  of  addiction. 

The  amount  of  cocaine  which  can  be  produced  from  the  coca  leaves 
imported  annually  is  approximately  150,000  ounces.  This  is  suffi- 
cient to  furnish  every  man,  woman,  and  child  of  the  countiy  with  2^ 
doses.  It  is  estimated  that  only  25  per  cent  of  this  is  used  in  legiti- 
mate medical  or  dental  practice.  Therefore,  75  per  cent,  or  112,500 
ounces  of  cocaine  which  is  manufactured  in  this  country  is  used  for 
illicit  purposes,  and  this  does  not  include  that  quantity  which  is 
smuggled  into  this  country,  of  which  no  estimate  can  be  made. 

INFORMATION  OBTAINED  FROM  REPLIES  TO  QUESTIONNAIRES. 

In  order  to  make  a thorough  and  complete  survey  of  narcotic  drug 
addiction  in  all  its  phases,  the  committee  formulated  seven  question- 
naires, embodying  questions  covering  the  important  points  on  which 
it  appeared  desirable  to  secure  information.  Each  of  these  question- 
naires was  so  arranged  that  it  would  bring  forth  the  information 
which  the  persons  addressed  might  possess,  and  at  the  same  time  be 
best  adapted  for  the  compilation  of  the  statistics  given. 

The  first  two  were  preliminary  questionnaires,  one  addressed  to  all 
physicians  registered  under  the  Harrison  Narcotic  Act,  requesting 
118256°— 19 2 


10 


data  as  to  the  number  of  addicts  under  treatment  by  them  at  the  time, 
and  the  other  questionnaire  was  addressed  to  druggists,  requesting  a 
statement  showing  the  number  of  narcotic  prescriptions  filled  by  them 
and  the  quantities  of  certain  preparations  containing  narcotic  drugs 
which  were  exempt  under  section  6 from  all  of  tlie  provisions  of  the 
original  act. 

ADDICTS  UNDER  TREATIMENT  BY  PHTSICIANS. 

Replies  were  received  from  ap2:)roximately  30|  jier  cent,  of  the 
physicians  registered  in  the  different  States,  and  these  showed  that 
there  were  under  treatment  at  that  time  a total  of  73,150  addicts.  On 
the  basis  of  100  per  cent  replies,  if  the  same  average  was  maintained, 
there  were  under  treatment  at  the  time  this  questionnaire  was  sent  cmt 
a total  of  237,655  addicts.  The  following  table,  shows  in  detail  by 
States  the  number  of  addicts  reported  under  treatment,  the  per- 
centage of  rejilies  receiA  ed  from  jihysicians,  and  the  estimated  num- 
ber on  the  basis  of  100  per  cent  replies. 


NuDiber  of  addicts  rcitoitcd  by  fihijsukuts. 


States. 

Addicts 

reported. 

Per  cent 
of  physi- 
eiatrs 
replying. 

Estimat- 
ed num- 
ber of  ad- 
dicts for 
100  per 
cent 
replies. 

States. 

Addicts 

reported. 

Per  cent 
of  physi- 
cians 
repiying. 

E.stimat- 
cd  num- 
ber of  ad- 
dicts for 
100  per 
cent 
replies. 

739 

11,  C90  ; 

Nebraska 

339 

GSi 

536 

10 

30 

33 

Nevada 

50 

275 

183 

Arizona 

353 

(') 

.353 

Nen'  HatnspUire... 

1,363 

39-1 

3.460 

1.250 

1,895 

New  Jersey 

2,274 

5, 900 

912 

271 

3,338 

New  Mexico 

413 

*413 

584 

GO 

'974 

New  York 

12, 365 

33J 

37, 095 

974 

1.740 

North  Carolina 

2;  211 

27| 

8!  077 

ittti 

42 

395 

Norlh  Dakota 

153 

163 

913 

District  olColumbia 

443 

42 

1 , 05.5 

Ohio 

4,161 

614 

6,749 

882 

25j 

3,425 

Oklahoma 

2,422 

4,500 

2.2'i2 

58^ 

3,865 

Oregon 

369 

16j 

’7W) 

99 

(i)' 

99 

i’ennsylvania 

3.791 

3G| 

10  202 

7 

4 

S75 

Rliodc  Island 

548 

S80 

lilinois 

2. 274 

27 1 

8,218 

South  Carolina 

73 

(‘) 

73 

1.540 

IS! 

8.438 

South  Dakota 

175 

16} 

1,045 

1. 158 

45-1 

2,456 

Tennessee 

5.366 

8,180 

1.  477 

77i 

1,918 

Texas 

498 

21’ 

2,371 

1.012 

42l 

3,972 

Utah 

4,375 

Louisiana 

1.110 

4 

17; 020 

Vermont 

612 

34 

i!554 

427 

39 1 

1,081 

Virginia 

2, 566 

65} 

584 

3,931 

MaiTland. 

1.0G2 

42'' 

2, 530 

AVashington 

1,373 

2,3-17 

Massachusetts 

2,272 

161- 

13,770 

i West  V&ginia 

1.642 

7l| 

2,286 

Micliigan.’. 

2, 752 

474 

5,757 

Wisconsin 

422 

D) 

422 

1.249 

69-:^ 

1.802 

60 

60 

100 

o.ny 

fii 

Missouri 

9.  SiP.9 

14| 

26! 958 

Total 

73,150 

305 

237,655 

Montana 

10 

2,000 

‘Per  cent  replying  can  not  be  giTcn,  as  collectors  siimmarised  lire  data  and  did  not  fornish  tlie  num- 
ber of  reports. 


NARCOTIC  PKESGRIPTIONS  FILLED  BY  DRUGGISTS. 

Answers  to  the  preliminary  questionnaire  addressed  to  druggists, 
of  Avhom  52  jier  cent  rejilied,  show  that  there  was  a total  of  9,511,938 
narcotic  jU’escri^itionB  filled  Avithin  one  year.  On  the  basis  of  100  per 
cent  replies,  if  the  same  conditions  prevailed  in  the  different  sections 


11 


of  the  country,  there  was  filled  during  this  period  a total  of  18,299,- 
397  pi’escriptions  containing  narcotic  drugs.  The  following  table 
gives  in  detail  the  infoi’mation  obtained  upon  this  point  by  this  ques- 
tionnaire : 


2^uml)er  of  narcotic  prescriptions  dispensed,  as  reported  hij  druggists. 


States. 

Narcotic 

prescrip- 

tions 

reported. 

Per  cent 
of  drug- 
gists re- 
plying. 

Esti- 
mated 
number 
of  pre- 
scriptions 
for  100. 
per  cent 
replies. 

Alabama 

264,443 

47A 

540, 124 

Alaska 

1,427 

72J 

1,965 

Arizona 

28, 1S7 

(') 

28, 187 

Arkansas 

141, 903 

781 

180, 708 

California 

270,334 

100 

270,334 

Colorado 

87,234 

60| 

143, 792 

Connecticut 

151,857 

735- 

207, 455 

Dclavrare 

District  of  Colum- 

23,650 

44i 

53,446 

bia 

88, 676 

441 

200,963 

Elorida 

132,019 

621 

181,059 

Georgia....... 

311,226 

64i 

490, 273 

Hawaii 

551 

(D 

551 

Idaho 

2,794 

24 

99,785 

Illinois 

454, 761 

274 

1, 659, 711 

Indiana 

188,005 

731 

256,837 

Iowa 

m,909 

724 

153,721 

Kansas 

150, 297 

781 

191,217 

Kentuckv 

213,434 

661 

• 320,151 

Louisiana 

227,681 

871 

261, 102 

Maine 

50,612 

23| 

213,853 

Maryland 

281,809 

441 

643, 636 

Massachusetts 

401, 180 

811 

492, 246 

Michigan 

201, 418 

53  .*5 

373, 688 

Minnesota..... 

157, 126 

92 

170,789 

Mississippi 

130, 447 

47rit 

271,593 

Missouri 

253, 782 

674 

374,309 

States. 

Narcotic 

prescrip- 

tions 

reported. 

Per  cent 
of  drug- 
gists re- 
pl.viug. 

Esti- 
mated 
number 
of  pre- 
scriptions 
for  100 
per  cent 
replies. 

Montana 

4,612 

24 

169, 000 

Nebraska,  .v 

88,420 

75 

117, 893 

Nevada 

2,997 

100 

2,997 

Ne>,v  Hampshire 

23, 267 

23§ 

98,311 

New  Jersey 

389,073 

674 

565, 584 

New  Mexico 

23,097- 

(■) 

23,007 

Ne^v  York 

1,381,646 

50 

2,763, 292 

North  Carolina..... 

• 313,048 

m 

462, 632 

North  Dakota 

38, 612 

32 

120, 662 

Ohio 

361,886 

• 75J 

480, 370 

Oklahoma 

148, 075 

56 

264,419 

Oregon 

S2, 351 

734 

109, 470 

Pennsylvania 

1,012,223 

424 

2,365,007 

Rhode  Island 

85,019 

734 

118, 877 

South  Carolina 

138, 533 

0) 

138, 533 

South  Dakota 

39, 285 

32 

122, 765 

Tennessee 

322,583 

67| 

476, 137 

Te.vas 

65,429 

8 

817, 862 

Utah.. 

433 

24 

15, 464 

Vermont 

26,855 

23J 

113, 472 

Virginia 

229, 881 

37 

621,300 

Washington 

103, 237 

72\- 

146, 332 

West  Virginia 

130, 881 

764 

171,813 

Wisconsin 

169,549 

76i 

221, 632 

Wyoming 

6,674 

60j 

11,001 

Total 

9,511,938 

52 

18,299,397 

1 Per  cent  rcpljang  can  not  be  given,  as  collectors  summarized  the  data  and  did  not  furnish  the  num- 
ber of  reports. 


NARCOTIC  PREPARATIONS  DISPENSED  WHICH  ARE  EXEIMPT  UNDER  THE  LAW. 

In  addition  to  the  above  information,  the  druggists  were  requested 
to  furnish  a statement  of  the  quantities  of  the  exempt  preparations  dis- 
pensed— Bateman’s  Drops,  Godfrey’s  Cordial,  paregoric,  etc.  The 
replies  received  showed  that  a total  of  1,294  gallons  and  175,858  bot- 
tles of  Bateman’s  Drops  had  been  sold  by  52  per  cent  of  the  druggists 
who  replied.  Estimated  on  the  basis  of  100  per  cent  replies,  there 
was  a total  of  2,508  gallons  and  312,934  bottles  of  this  exempt  prepara- 
tion sold  by  druggists  within  one  year. 

Th  ese  druggists  also  reported  the  sale  of  1,274  gallons  and  228,344 
bottles  of  Godfrey’s  Cordial.  On  the  basis  of  52  per  cent  replies, 
this  indicates  a total  of  2,584  gallons  and  441,056  bottles  of  this  prep- 
aration sold  within  the  same  period. 

Sales  of  paregoric  were  reported  as  follows;  77,383  gallons  and 
10,012  bottles.  Basing  the  estimate  of  the  total  upon  the  52  per  cent 
of  druggists  who  replied,  there  was  sold  a total  of  143,328  gallons  and 
18,435  bottles  of  paregoric  within  one  year. 


12 


For  detailed  statistics  of  the  sales  of  these  various  preparations,  see 
the  following  tables. 

Bateman’s  Drops,  Godfrey's  Cordial,  and  pareyoric  dispensed,  as  reported  hy 

druggists. 


BATEMAN’S  DROPS. 


States. 


Per  cent 
replying. 


Alabama 

Arkansas 

Delaware 

District  of  Columbia. 

Florida 

Georgia 

Illinois 

Indiana 

Iowa 

Kan.sas 

Kentucky 

Louisiana 

Maryland 

Miofiigan 

Minnesota 

Mississippi 

Missouri 

Nebraska 

New  Jersey 

New  York'. 

North  Carolina 

Ohio 

Oklahoma 

Pennsylvania 

South  Carolina 

Tennessee 

Tc.xas 

Virginia 

Wasiiington 

AVest  Virginia 

AVi-sconsin 

Total 


7sF 

44} 

44} 

62} 

64i 

27| 

73} 

72} 

66| 

87} 

44} 

5^*5 

92 

47t-\ 

67} 

75 

07} 

50 

67:} 

73j 

56 

42} 

(') 

675 

8 

37 

72} 


52 


Reported  to  Number  for  100  per 

collectors.  cent,  estimate. 


Gallons. 


Bottles. 


Gallons. 


Bottles. 


27 

3 

20 


17 

103 

5 

7 


1 

4 

5 
14 


1 

1 


25,781 
876 
1,089 
391 
10, 418 
31,254 
1,001 
1,185 
89 
791 
6,958 
39 
5,444 
10 
84 
375 
1,545 
6 


57 

54,372 

4 

1,110 

45 

2,461 

883 

20 

16,749 

159 

48, 455 

17 

3,653 

9 

1,818 

122 

1 

1,065 

6 

10,437 

5 

44 

31 

12,264 

29 

91 

2 

790 

1 

2,278 

8 


174 

7 

267 

53 


218 

12 

36 


303 


10 


2 

10, 591 
8,410 
587 
2,345 
10,440 
7,440 
61 

26,719 

3 

21,902 

16 


259 

14 

394 

70 


509 

12 

53 


819 


21 


4 

15,653 
11,164 
1,048 
5,460 
10, 440 
10,981 
762 
72,213 
4 

28, 755 
20 


1,294 


175,858 


2, 508 


312,931 


GODFREY’S  CORDIAL. 


47A- 

(') 

78-^ 

100 

83 

11,042 

18 

175 

24,552 

18 

13,969 

130 

16 

10,966 

136 

20 

GOr 

26 

42 

73} 

1 

15 

1 

20 

43} 

27 

543 

CO 

1,227 
2, 290 

44} 

62} 

2 

1,016 

4 

18 

6, 839 

28 

10, 995 
27,353 
35, 372 
17, 460 
719 

64^V 

48 

17, 643 
9,692 
12,785 
524 

74 

27} 

26 

95 

73} 

24 

32 

72t 

78J 

2 

1,654 

13,549 

5ti3 

2 

2, 104 
20,323 
640 

20 

30 

S7l 

G 

44} 

8U 

53A 

47-1^ 

62 

8,734 

181 

140 

19,737 

222 

15 

10,361 

2,465 

8,042 

21 

28 

19,222 
5, 198 

2 ' 

4 

G7f 

7 

10 

11,861 

28 

75“ 

G7.1 

(') 

50 

30 

35 

45 

52 

42 

42 

22 

5,578 

18,362 

20,749 

5,587 

44 

11, 150 
27, 138 
35,509 
9, 977 
17,717 

G7^ 

221 

326 

751 

183 

243 

5G 

I’ennsylvania 

42} 

83 

7,583 

194 

' Per  cent  replying  can  not  bo  given,  as  oolleotors  summarized  the  data  and  did  not  furnish  the  number, 
of  reports. 


13 


Bateman's  Drops,  Godfrey's  Cordial,  and  paregorie,  efc.— Continued. 

GODFREY’S  CORDIAL— Continued. 


States. 

Per  cent 
replying. 

Reported  to 
coliectors. 

Number  for  100  per 
cent,  estimate. 

Gallons. 

Bottles. 

Gallons. 

Bottles. 

Tii 

0) 

32 

e7j 

8 

23j 

37 

72? 

76J- 

76i 

130 

11,781 

12 

21, 295 
730 
12 
4,491 
40 
8,308 
194 

177 
11,781 
37 
31,432 
9, 125 
51 
12, 138 
55 
10, 909 
254 

14 

14 

39 

57 

309 

1 

12 

1 

835 

1 

16 

1 

Total 

52 

1,274 

228, 344 

2, 486 

441,056 

PAREGORIC. 


Alabama 

Alasica 

Arizona 

Arkansas 

California 

Colorado 

Connecticut 

Delaware 

District  of  Columbia. 

Florida 

Georgia 

Hawaii 

Idaho 

Illinois 

Indiana 

Iona 

Kansas 

Kentucky 

Louisiana..  4.. ...... 

Maine 

Maryland. . .'. 

Massachusetts 

Michigan 

Minnesota 

Mississippi 

Missouri 

Montana 

Nebraska 

Nevada 

New  Hamp.shire 

New  Jersey 

New  Mexico 

New  \ ork 

NorthCarolina 

North  Dakota 

Ohio 

Oklahoma 

Oregon 

Peiuisylvania 

Rhode  Island 

South  Carolina 

South  Dakota 

Tennessee 

Texas 

Utah 

Vermont 

Virginia 

Washington 

West  Virginia 

Wisconsin 

Wyoming 

Total 


47A 

5,904 

1,344 

12,451 

2,834 

72? 

1 

2 

(’) 

143 

143 

784 

2,091 

92 

2, 663 

111 

lOO 

2,048 

2,048 

60i| 

45 

74 

7.34 

1,383 

1,889 

.364 

72 

'823 

162 

457 

1, 032 

62? 

1,586 

2,909 

2,549 

4,677 

644 

4,108 

3,224 

6,369 

4, 999 

(') 

40 

40 

7 

2o0 

m 

2,303 

888 

8,412 

3, 240 

73? 

2,654 

6 

3,628 

8 

72? 

411 

564 

78^- 

484 

615 

66? 

1, 746 

60 

2,619 

90 

2,390 

332 

2, 740 

381 

231 

826 

3,470 

44i 

2,814 



6,3.59 

8U 

3,404 

4,176 

i;o2o 

24 

1,892 

44 

92 

382 

415 

47A 

905 

326 

2,013 

770 

67^ 

608 

896 

94 

4 

144 

75^ 

336 

448 

100 

194 

194 

23| 

327 

1,381 

67i 

3,185 

4,739 

(') 

96 

96 

50 

9,038 

18, 076 

673 

3,062 

133 

4,525 

196 

32 

85 

265 

75| 

3, 929 

56 

153 

273 

73^ 

342 

466 

42f 

8,637 

84 

20, 179 

190 

73^ 

586 

800 

(1) 

1, 126 

1, 120 

32 

208 

67i 

2,741 

236 

4,046 

348 

8 

52 

650 

2* 

4 

144 

23I 

220 

920 

3,127 

24 

8, 451 

65 

72? 

505 

10 

696 

14 

76J 

895 

228 

1,175 

300 

76? 

389 

508 

60§ 

18 

29 

52 

77,383 

10,012 

143, 328 

18,435 

* Per  eent  replying  can  not  be  given,  as  collectors  summarized  the  data  and  did  not  furnish  the  number  of 
reports. 


14 


In  ©xplanation  of  tiie  abore  figures,  it-  may  be  stated  that  they  do 
not  include  the  sale  of  other  exempt  j>i-eparations  which  were  made  up 
by  drug-gists  and  of  which  no  record  was  kept,  nor  do  they  show  the 
sales  of  the  same  or  similar  prei^arations  by  grocers  and  other  whole- 
salers and  retailers  who,  in  certain  States,  are  permitted  to  sell  these 
exempt  preparations  Avithout  restriction. 

In  addition  to  the  above-mentioned  questionnaires,  the  committee 
sent  out  fi^'e  othei-s,  as  follows: 

rOniCE  STATISTICS  ox  ABDICTION, 

Questionnaire  No.  1 was  addressed  to  the  chief  of  police  of  each  of 
the  1,263  cities  in  the  United  States  Imving  a population  of  5,000  or 
more.  Keplies  were  received  from  760,  of  Aidiicli  ZSS  contained  cer- 
tain infonnation,  while  372  reported  that  they  had  no  available 
records  or  data,.  This  represents  replies  of  approximately  GO  per  cent 
to  the  questionnaires,  but  only  about  32  per  cent  contained  any  in- 
formation. 

Tlie  police  officials  in  31  cities  reported  an  iaca-ease  in  nareotic  drag 
addiction,  ivhile  287  cities  reported  a decrea^.  The  inci-eases  re- 
ported were  from  the  larger  cities,  while  the  decreases  occurred  in 
the  smaller  cities.  Of  those  reporting  an  increase,  8 gave  as  a cause 
for  this  condition,  prohibition;  8,  association  with  other  addicts;  6. 
because  of  free  use  of  drags  by  physicians ; 4 reported  increase  due  to 
immigration;  2 ascribed  the  increase  to  the  creation  of  addicts  by 
vendoi-s  because  of  the  large  profits;  while  1 re-iiorted  it  due  to  lax 
laws. 

Of  those  reix)rfcing  a decrease  in  addiction,  80  ascribed  tliis  to  the 
Harrison  iiai-cotic  iaAv;  62  stated  it  was  due  to  the  difficultj^  in  pro- 
curing drugs;  26  to  the  laws  in  general;  24  gave  as  a reason  State 
laws;  12  ascribed  the  decrease  to  the  actnity  of  police  officials;  11  said 
it  was  due  to  the  high  price  of  drugs ; 11  on  accoimt  of  prohibition ; 11 
because  of  death  of  addicts;  9 because  of  pmsecutions  for  violations 
of  laws;  9 because  of  restricted  .sales;  9 because  of  en\igi*atiori  of 
addicts  to  other  pails;  5 to  treatment  and  cure  of  addicts;  2 to  actii’^- 
ities  of  the  State  board  of  pharmacy;  1 because  of  refusal  of  physi- 
cian to  prescribe  drugs,  and  1 because  of  the  selective  draft. 

The  causes  for  drug  addiction  in  the  order  of  their  frequenc}'’ 
were  gii'en  as  follows;  Use  of  physicians’  prescriptions,  association 
Avith  other  addicts,  prohibition,  use  of  narcotic  drugs  for  chronic 
diseases,  curiosity  to  learn  the  effects  of  the  drug,  prostitution,  use 
of  patent  or  proprietary  medicines,  use  of  certain  narcotic  drugs  as 
a stimulant,  idleness,  and  use  by  dentists. 

With  respect  to  the  order  of  frequency  in  which  the  different 
drugs  were  used  they  reported  as  folloAA's;  Morphine,  cocaijie, 
heroin,  opium,  laudanum  and  jiaregoric,  and  codeine. 


15 


These  officials  also  reported  the  arrest  of  5,534  persons  addicted 
to  the  use  of  drugs  in  1916;  5,628  in  1917;  and  5,443  in  1918.  The 
population  of  the  cities  represented  by  these  officials  was  26,514,361, 
or  approximately  25  per  cent) of  the  total  population  of  the  country. 
If  the  same  record  of  arrests  prevailed  throughout  the  smaller  cities 
and  rural  districts,  the  number  of  addicts  arrested,  based  on  the 
population  of  the  entire  countiy,  Avould  be  21,772  for  1918.  The 
offenses  for  which  arrests  of  addicts  were  made  are  given  in  their 
order  of  frequency  as  follows;  Larceny,  burglary,  robbery  other 
than  larceny,  vagrancjq  prostitution,  disorderly  conduct,  assault  and 
battery,  drunkenness,  murder,  and  forgery.  In  further  explanation 
of  these  arrests  it  is  stated  by  46  officials  that  morphine  was  used  by 
persons  committing  violent  crimes;  46  stated  that  cocaine  was  used 
by  persons  committing  violent  crimes;  18  reported  heroin,  and  4 re- 
ported opium  as  the  drug  used  by  such  persons.  With  respect  to  the 
lesser  crimes,  62  officials  reported  morphine  as  the  drug  used  by  such 
persons,  23  reported  cocaine,  14  opium,  13  heroin,  18  paregoric,  2 
laudanum,  1 codeine,  and  1 yen  shee. 

These  police  officials  also  reported  1,800  drug  peddlers  doing  busi- 
ness in  the  United  States  at  the  present  time.  A number  of  these 
officials  stated  that  they  knew  it  to  be  a fact  that  peddlers  secured 
their  siipi^lies  by  smuggling  from  Canada  and  Mexico.  Others  stated 
that  smuggling  from  other  countries,  stealing,  and  through  pi-e- 
scriptions  written  by  unscrupulous  physicians  constituted  the  chief 
means  of  securing  these  drugs.  The  occupations  of  the  peddlers  were 
given  as  follows:  Gamblers,  taxicab  drivers,  domestics,  solicitors, 
messengers,  vagrants,  lunch  room  helpers,  pool  room  employees, 
porters,  laundrymen,  etc. 

STATISTICS  FROM  PEXAL  INSTITUTIONS. 

Questionnaire  No.  2 was  sent  to  a total  of  3,271  wardens  of  State, 
county  and  municipal  prisons  and  reformatories,  to  which  762  re- 
plied. Of  these  replies  126  contained  certain  information,  and  636 
were  returned  with  the  statement  that  no  records  had  been  kept  and, 
therefore,  no  information  was  available.  The  total  number  of  re- 
plies received  represents  23  per  cent  of  the  questionnaires  sent  out, 
but  the  number  containing  information  represents  only  3.9  per  cent 
of  the  total  sent  out. 

The  census  report  of  1910  shows  the  number  of  inmates  of  penal 
or  reformatory  institutions  on  January  1 of  that  year  and  during  the 
year  1910  to  have  been  630,406.  Figures  showing  the  total  number 
of  inmates  confined  in  such  institutions  during  the  years  1916,  1917, 
• and  1918  Avere  not  available,  but  the  replies  to  the  questionnaire  shoiv 
that  there  were  1,376  addicts  in  1916,  2,176  in  1917,  and  1,861  con- 
fined in  such  prisons  during  1918.  These  figures  would  apparently 


16 


indicate  thpl;  only  a small  percentage  of  persons  incarcerated  in  penal 
institutions  are  addicted  to  dinigs,  but  this  is  an  assumption  which 
is  partly  negatived  by  the  fact  that  only  a very  small  percentage  of 
such  institutions  kept  an}’"  records  relative  to  drug  addiction. 

The  following  table  gives  information  relative  to  the  drugs  used  by 
addicts  who  were  inmates  of  these  institutions. 


Classification  of  addicts  in  above  institutions  according  to  drug  of  addiction. 


Drug. 

1916 

1917 

1918 

Total. 

Drug. 

1916 

1917 

1918 

Total. 

Gum  opium 

Smoking  opium 

Morphine 

Heroin 

Codeine 

Laudanum 

5 
76 

431 

588 

4 

6 

53 

101 

648 

829 

7 

2 

29 

83 

626 

508 

4 

8 

87 

260 

1,705 

1,925 

15 

16 

Paregoric 

Cocaine 

Cannabis  or  hashish . 

Total 

3 

100 

10 

5 

144 

19 

12 

133 

20 

20 

377 

49 

1,223 

1,808 

1,423 

4,454 

The  officials  of  these  institutions  reported  the  predisposing  causes 
of  addiction  as  follows : Low  mentality  in  198  cases,  nervous  diseases 
in  55  cases,  chronic  or  painful  illness  in  49  cases,  and  other  predispos- 
ing causes  in  125  cases. 

The  manner  in  which  the  habit  Avas  acquired  was  reported  to  be  as 
follows:  Through  direct  administration  by  physicians  in  64  cases, 
through  physicians’  prescriptions  in  240  cases,  through  self-medica- 
tion or  the  use  of  proprietary  remedies  in  18  cases,  through  association 
Avith  other  addicts  in  974  cases,  through  other  ways,  including  the 
white-slaA'e  traffic  in  42  cases,  and  through  surgical  operations  in  23 
cases. 

The  order  of  frequency  of  addiction  according  to  nativity  was  giv'en 
as  follows:  American,  Italian,  Irish,  English,  Eussian,  JeAvish. 
French,  Negroes  or  Chinese,  Mexican  or  Austrian,  German  or  Ca- 
nadian. 

The  reports  of  these  officials  also  shoAv  that  there  Avas  no  connection 
betv'een  occupation  and  addiction,  although  they  reported  that  the 
occupations  of  addicts  in  the  order  of  their  frequency  are:  Waiters, 
waitresses,  chemists,  paper  hangers,  laundrymen,  laundresses,  paint- 
ers, cooles,  mechanics,  chauffeurs,  tailoi’s,  salesmen,  laborers,  prosti- 
tutes, and  vagrants. 

STATISTICS  OBTAINED  FKOJI  ALMSHOUSES. 

Questionnaire  No.  3 Avas  sent  to  2,464  superintendents  of  State, 
county,  and  municipal  almshouses;  584  to  superintendents  of  State 
hospitals;  471  to  superintendents  of  insane  asylums;  1,582  to  county 
and  municipal  hospitals,  making  a total  of  5,101  institutions.  Only 
1,520  replies  Avere  received,  or  approximately  30  per  cent,  of  the  total  • 
number  mailed.  Of  these,  only  330  contained  information,  or,  in  other 
Avoids,  only  about  6 per  cent  of  the  institutions  gave  any  information 


17 


of  value  to  the  committee.  These  replies  showed  that  1,774  addicts 
had  been  treated  in  these  institutions  during  1916,  1,535  during  1917, 
and  1,449  during  1918. 

With  respect  to  the  drug  of  addiction.  111  were  reported  as  using 
gum  opium,  157  smoking  opium,  3,072  morphine,  900  heroin,  30  co- 
deine, 75  laudanum,  123  paregoric,  and  24  cocaine. 

As  predisposing  causes  for  addiction,  low  mentality  or  arrested  de- 
velopment was  mentioned  in  924  cases,  nervoits  diseases  in  266  cases, 
chronic  or  painful  illness  in  590  cases,  surgical  operations  in  160  cases, 
and  unclassified  causes  in  595  cases. 

In  respect  to  the  request  for  information  relating  to  the  manner  in 
which  addiction  was  acquired,  direct  administration  by  ph3''sicians 
was  reported  in  280  cases,  through  physicians’  prescriptions  in  364 
cases,  through  self-medication  and  the  use  of  patent  or  proprietary 
remedies  in  206  cases,  through  association  with  other  addicts  in  1,275 
cases,  and  through  other  ways  in  355  cases. 

The  relative  frequency  of  addiction  in  the  above  cases  with  respect 
to  nationality  was  given  as  follows;  American,  Canadian,  Irish, 
English,  German,  Scotch,  Russian,  French,  Italian,  Chinese,  Mexi- 
can, Armenian,  Swiss,  and  Swedish. 

The  occupations  of  addicts  in  order  of  their  frequency  wei’e  given 
as  follows:  Housekeepers,  laborers,  clerks,  physicians,  salesmen, 
nurses,  pharmacists,  actors,  prostitutes,  waiters,  cooks,  sailors  and 
soldiers,  horsemen,  barbers,  butchers,  bartenders,  draftsmen,  teachers, 
and  unemployed. 

The  institutions  wliich  replied  to  the  question  relating  to  diseases 
from  which  the  addicts  were  suffering,  reported  that  40  were  suffer- 
ing from  rheumatism,  45  from  cancer,  62  from  asthma,  159  from 
heart  disease  and  nervous  troubles,  106  from  tuberculosis,  148  from 
venereal  diseases,  71  from  chronic  diseases  unclassified,  and  56  from 
insanity. 

Of  the  total  number  of  institutions  replying,  79  stated  that  they 
gave  special  treatment  for  narcotic  drug  addiction.  The  average 
length  of  time  of  treatment  of  an  addict  is  reported  as  being  2 years 
lOJ  months.  The  average  daily  cost  per  capita  for  treatment  and 
maintenance  was  stated  to  be  $1.29. 

HEALTH  OFFICEIJS’  REPORTS. 

Questionnaire  No.  4 was  addressed  to  3,023  State,  district,  county, 
and  municipal  health  officers.  To  this  questionnaire,  983  replies  were 
received,  or  33  per  cent  of  the  total  number  sent  out.  Only  777  of 
these,  or  26  per  cent  of  the  total,  contained  any  information  of  value 
to  the  committee.  Most  of  these  officials  replied  to  the  effect  that 


18 


they  kept  no  records  of  the  number  of  drug  addicts,  nor  had  they  any 
means  of  securing  such  information. 

The  number  of  addicts  reported  by  the  officials  replying  was  given 
as  5,271  in  1916,  3,542  in  1917,  and  2,877  in  1918. 

The  officials  in  14  cities  and  counties  reported  an  increase  in  drug 
addiction.  The  cause  of  the  increase  \Yas  given  as  immigration  in 
4 reports,  prohibition  in  3 reports,  lax  laws  in  2 reports,  and  war 
conditions  in  1.  Officials  in  627  cities  and  counties  reported  a de- 
crease in  number  of  addicts  during  this  same  period.  The  cause  for 
decrease  was  given  as  the  Harrison  narcotic  law  in  317  reports,  ina- 
bility to  obtain  drugs  in  145  reports,  laws  in  general  in  46  reports. 
State  and  Federal  laws  in  36  reports,  deaths  in  23  reports,  treatment 
and  cures  in  21  reports,  cooperation  of  physicians  in  20  reports, 
emigration  in  12  reports,  prohibition  in  8 reports,  high  cost  of 
drugs  in  7 reports,  efforts  to  prohibit  sales  in  6 reports,  cooperation  of 
authorities  in  5 reports,  employment  in  war  work  in  3 reports,  prose- 
cution in  3 reports,  and  environment  in  2 reports. 

The  predisposing  causes  of  drug  addiction  in  order  of  their  fre- 
quency as  stated  in  these  reports  are  chronic  diseases,  prostitution, 
mental  troubles,  nervousness,  and  neurasthenia. 

The  ways  in  which  the  habit  was  acquired,  stated  in  the  order  of 
their  frequency,  are  as  follows:  Through  physicians’  prescriptions, 
use  of  drugs  for  chronic  diseases,  prohibition,  association,  use  of 
patent  medicines,  prostitution,  as  a means  of  producing  stimulation, 
and  through  curiosity. 

In  reply  to  the  question  relative  to  the  nature  of  drug  addiction, 
425  health  officials  stated  that  the  physicians  in  their  communities 
regarded  it  as  a disease,  while  542  reported  that  they  regarded  it  as 
a vice. 

With  respect  to  the  treatment  of  drug  addiction,  88  health  officials 
reported  that  physicians  in  their  community  followed  special  pro- 
cedures in  the  treatment  of  addicts,  while  351  reported  that  the  phy- 
sicians followed  the  procedure  commonly  known  as  the  reduction 
treatment.  These  health  officials  also  stated  that  192  cities  and  coun- 
ties over  which  they  had  jurisdiction  make  provision  for  the  treatment 
of  addicts  in  almshouses  and  penal  institutions. 

PRIVATE  HOSPITALS  AND  SANATORIA. 

Questionnaire  No.  5 was  sent  to  4,568  superintendents  of  private 
hospitals  and  sanatoria.  Eeplies  equal  to  36  per  cent  of  the  total  sent 
out  were  received.  Only  227  of  these  questionnaii’es,  however,  con- 
tained any  information  of  value  to  the  committee.  Most  of  them  re- 
plied that  no  records  were  kept,  or  that  the  records  of  the  institution 
were  not  arranged  in  such  manner  as  would  give  the  information 
desired. 


19 


The  replies  received  showed  that  506  addicts  were  being  treated 
in  these  institutions  during  the  year  1910,  551  during  1917,  and  624 
in  1918.  Of  the  total  number  of  patients  treated  by  these  institutions 
for  the  three-year  period,  27  used  giun  opium,  21  smoking  opium,  1,05_6 
morphine,  297  heroin,  28  codeine,  17  laudanum,  55  paregoric,  aird  28 
cocaine. 

As  predisposing  causes  for  drug  addiction,  low  mentality  or  ar- 
rested development  was  given  in  102  cases,  nervous  diseases  in  195 
cases,  chronic  or  painful  illness  in  180  cases,  surgical  operations  in  154 
cases,  and  other  predisposing  causes  in  200  cases. 

With  respect  to  the  manner  in  which  addiction  had  beeii  acquired, 
direct  administration  by  physicians  was  given  in  133  cases,  the  use  of 
physicians’  prescriptions  in  93  cases,  self-medication  in  117  cases,  asso- 
ciation with  other  addicts  in  205  cases,  and  in  other  v/ays,  including 
the  white-slave  traffic,  in  270  cases. 

The  nationality  of  addicts,  where  such  information  was  given,  is 
reported  as  American  in  94  instances,  German  in  10,  Irish  in  8,  Eng- 
lish and  Scotch  in  6,  Jewish  in  5,  French  in  4,  Austrian  in  3,  Kussian 
and  Grecian  in  3,  and  Mexican  in  2. 

The  occupations  of  addicts  in  the  order  of  their  frequency  are  re- 
ported as  follows : Housewives,  laborers,  physicians,  salesmen,  actors 
and  actresses,  unemployment,  business  men,  nurses,  farmers,  office 
workers,  professional  men  and  women,  prostitutes,  pharmacists, 
“dope”  peddlers,  mechanics,  merchants,  gamblers,  newspapermen, 
and  printers. 

The  diseases  of  addicts  other  than  that  of  addiction  are  reported 
as  venereal  in  109  cases,  tuberculosis  in  1-1  cases,  nervous  troubles  in 
198  cases,  insanity  in  66  cases,  lung  diseases  other  than  tubei'culosis 
in  39  cases,  abscess  and  cancer  in  84  cases,  stomach  troubles  in  5 cases, 
and  heart  disease  in  7 cases. 

These  private  institutions  reported  that  the,  average  length  of  time 
of  treatment  of  opium  addicts  was  61  weeks,  morphine  addicts  7 
weeks,  and  cocaine  addicts  6 weeks.  The  average  cost  per  cajaita  for 
treatment  and  maintenance  is  given  as  $5.21  per  day. 

Of  the  total  number  of  addicts  treated  in  these  institutions,  74  per 
cent  are  stated  to  have  been  benefited  to  some  degree,  and  61  per  cent 
are  said  to  ha’^  e been  permanently  cured  of  their  addiction. 

SU3IMAKr. 

Tra-fjic  in  ncircotic  drugs. — Statistics  compiled  by  the  Department 
of  Commerce  show  that  the  quantities  of  narcotic  drugs  imported  into 
this  country  steadily  increased  from  the  date  when  the  first  entries 
wer«  reported  until  our  chief  sources  of  supply  Avere  shut  off  as  a 
result  of  the  present  war.  In  1915  the  quantities  of  these  drugs  con- 
sumed in  this  country  amounted  to  approximately  490,000  pounds  of 
opium  and  more  than  1,000,000  pounds  of  coca  leaA^es.  These  quan- 


20 


titles  of  opium  and  coca  leaves,  in  their  crude  state  and  in  the  form 
of  manufactured  products,  were  supplied  to  the  public  through  a 
total  of  233,491  individuals  and  institutions  registered  under  the 
Harrison  Narcotic  Act.  The  minimum  value  of  these  drugs  com- 
puted on  the  basis  of  retail  price  of  the  crude  material  Avould  be  some- 
thing over  $20,000,000.  The  actual  cost  to  the  consumer,  Avhile  it 
greatljT^  exceeds  this  amount,  can  not  be  estimated  at  the  present  time. 
When  we  take  into  consideration  the  fact  that  various  investigators 
have  stated  that  only  from  10  to  25  per  cent  of  the  quantities  of  these 
drugs  imported  is  actually  needed  to  supply  the  demand  for  legiti- 
mate medical  purposes,  we  can  arrive  at  some  idea  of  the  quantities 
of  these  di’ugs  consumed  by  addicts  and  the  amount  of  money  ex- 
pended for  the  satisfaction  of  their  addiction. 

The  foregoing  represents  only  the  extent  of  this  traffic  as  carried  on 
through  legitimate  channels.  In  recent  years,  especially  since  the 
enactment  of  the  Harrison  law,  the  traffic  by  “ underground  ” chan- 
nels has  increased  enormously,  and  at  the  present  time  it  is  believed 
to  be  equally  as  extensive  as  that  carried  on  in  a legitimate  manner. 
This  traffic  is  chiefly  in  the  hands  of  so-called  “ dope  peddlers,”  who 
obtain  their  supplies  by  smuggling  from  Canada,  Mexico,  and  along 
the  Atlantic  and  Pacific  coasts. 

Extent  of  drug  addiction. — The  number  of  individuals  addicted  to 
the  use  of  opium,  its  preparations  or  alkaloids,  and  coca  leaves,  their 
pi'eparations  and  alkaloids,  in  the  United  States  has,  at  varioiis  times, 
been  estimated  to  be  from  200,000  to  4,000,000.  These  estimates 
must,  however,  be  looked  ujDon  as  mere  guesses  in  most  cases  because 
of  the  fact  that  there  have  been  no  means  available  for  reaching  an 
accurate  estimate  in  the  past.  The  following  table  shows  the  num- 
ber of  addicts  in  the  United  States,  or  parts  thereof,  as  estimated  by 
a number  of  different  investigators  who  have  made  a more  or  less 
extensive  study  of  the  situation. 


I^uiiihcr  of  addicts,  as  estimated  iij  various  observers. 


Observer. 

Year. 

Number  of 
addicts. 

United  States  or 
parts  thereof. 

Per  cent 
of  popu- 
lation. 

Kinds  of  addicts. 

1912 

1,000,000 

887 

United  States 

1.0 

50  per  cent  morphine. 
All  drugs. 

C.  E.  Terrv 

1913 

Jacksonville,  Fla . . 

1.31 

1915 

269,000 

5,000 

United  States 

.27 

Do. 

Do  

1915 

Tennessee 

• 22 

Do. 

M 7 AVilhprt 

1915 

175; 000 
80,000 
4,000,000 

United  States 

.175 

Opium. 

Cocaine. 

Do  

1915 

do 

.08 

1915 

4.0 

Opium-cocaine. 

Opium. 

All  drugs. 

1910 

100, 000 

do 

.1 

J.  R.  Campbell 

Massachusetts  committee  on 

1916 

1 15;  000 

New  York  State. . 

.16 

habit  forming  drugs. 

1917 

60,000 

Massachusetts 

1.6 

Do. 

George  H.  Whitney. 

1917 

100,000 

New  York  State. . . 

1.0 

Do. 

Earnest  F.  Bishop 

1918 

200,000 

do 

2.0 

Do. 

Do 

1918 

100,000 

New  York  City. . . 

1.8 

Do. 

L.  S.  Hinckley 

1918 

2,000,000 

United  States 

2.0 

Do. 

> Children. 


21 


Owing-  to  the  lack  of  laws  and  regulations  making  it  compulsory 
for  the  registration  of  addicts  throughout  the  country  or  the  keep- 
ing of  any  records  as  to  their  identity,  it  has  been  impossible  for  the 
committee  to  obtain  information  which  woidd  give  the  exact  numbeu 
of  addicts  in  the  United  States  at  the  present  time.  It  is  believed, 
however,  that  a fairly  accurate  estimate  of  their  number  can  be 
made  from  the  information  which  the  committee  has  obtained.  At- 
tempts to  accomplish  this  have  been  made  as  follows : 

The  number  of  addicts  reported  by  the  health  officials  replying 
to  questionnaire  No.  4 was  105,887.  As  this  number  represents  the 
addicts  reported  by  only  26  per  cent  of  the  health  officials  from 
which  this  information  was  requested,  it  may  be  assumed  that  had  all 
the  health  officials  replied  the  total  number  would  have  amounted 
to  approximately  420,000.  This  number,  however,  appears  to  be 
much  too  low,  in  view  of  the  fact  that  the  ph)^sicians  of  the  country 
are  estimated  to  have  had  about  237,000  addicts  under  treatment 
during  this  same  period,  and  only  a small  portion  of  the  total  num- 
ber of  addicts  present  themselves  for  treatment.  Addicts  of  the 
“underworld,”  for  instance,  secure  most  of  their  supply  through 
illicit  channels  and  rarely,  if  ever,  consult  a physician. 

It  appears  that  a more  accurate  estimate  of  the  total  number  of 
addicts  may  be  obtained  from  the  data  secured  by  those  investigators 
who  have  made  an  intensive  study  of  drug  addiction  in  certain  re- 
stricted communities.  For  example,  the  health  officer  of  Jaclcson- 
ville,  Fla.,  reported  887  addicts  in  that  city  in  1913.  This  number 
represents  1.31  per  cent  of  the  population.  Upon  this  basis  the  total 
nimiber  of  addicts  in  the  United  States,  in  1918,  taking  the  estimated 
population  as  106,000,000,  would  be  1,388,600. 

In  reply  to  questionnaire  No.  4 sent  to  health  officers  of  States, 
counties,  and  municipalities,  the  health  officer  of  New  York  City 
reported  a total  of  103,000  addicts,  which  is  equivalent  to  1.8  per  cent 
of  the  population.  On  this  basis,  there  would  be  1,908,000  addicts 
in  the  United  States. 

Information  in  the  hands  of  the  committee  indicates  that  drug 
addiction  is  less  prevalent  in  rural  communities  than  in  cities  or  in 
congested  centers.  It  would,  therefore,  be  unfair  to  estimate  the 
number  of  addicts  in  the  entire  country  on  the  basis  of  the  figures 
obtained  for  New  York  City.  Furthermore,  it  is  the  opinion  of  the 
committee  that  an  estimate  based  on  the  number  of  addicts  in  a 
small  city  like  Jacksonville,  Fla.,  would  not  be  representative  for 
the  entire  country.  Taking  these  facts  into  consideration,  the  com- 
mittee is  of  the  opinion  that  the  total  number  of  addicts  in  this 
country  probably  exceeds  1,000,000  at  the  present  time. 

..With  respect  to  the  increase  or  decrease  in  the  number  of  addicts 
within  the  last  year,  the  following  statements  can  be  made:  In  re- 


22 


sponse  to  the  question  Has  narcotic  dru^  addiction  increased  or  de- 
creased in  the  past  few  years?  which  inquii’y  was  directed  to  3,023 
health  officers  and  1,263  chiefs  of  police,  962  expressed  an  opinion. 
Forty-eight  stated  that  there  had  been  an  increase  and  914  reported 
a decrease.  Taking  into  consideration  the  population  of  the  cities 
or  counties  reported  by  the  officials  giving  these  opinions,  it  is  found 
that  in  practically  every  instance  the  increase  reported  was  from  the 
largest  cities,  and  in  particular  in  those  cities  where  more  than  the 
usual  attention  is  being  directed  to  the  eradication  of  drug  addiction. 
Thus  each  of  the  20  following  cities,  having  an  aggregate  population 
of  approximately  10,000,000  people,  have  reported  an  increase:  San 
Francisco,  Calif.;  Wilmington,  Del.;  Macon,  Ga. ; Louisville,  Ky. ; 
Bi’ockton,  Mass. ; Detroit,  Mich. ; Kansas  City,  Mo. ; Elmira,  N.  Y. ; 
New  York  City,  N.  Y. ; Utica,  N.  Y. ; Yonkers,  N.  Y. ; Charlotte, 
N.  C. ; Muskogee,  Okla. ; Oklahoma,  Okla. ; Toledo,  Ohio ; Portland, 
Oreg. ; Harrisburg,  Pa. ; Chattanooga,  Tenn. ; Knoxville,  Tenn. ; and 
Nashville,  Tenn. 

Keplies  in  which  a decrease  in  the  number  of  addicts  were  re- 
ported were  received  chiefly  from  rural  districts  or  smaller  cities 
Avhere  little  or  no  attention  has  been  given  this  subject,  so  that  it  is 
quite  possible  that  the  opinions  expressed  by  the  officials  resident  in 
these  places  are  at  variance  with  the  conditions  as  they  actually  exists 

What  effect,  if  any,  nation-wide  prohibition  muII  have  on  the  situa- 
tion could  not  be  definitely  determined  by  the  committee.  The  con- 
sensus of  opinion  of  those  interested  in  the  subject  appears  to  be  to 
the  effect  that  the  number  of  addicts  will  increase  as  soon  as  the  pro- 
hibition laws  are,  enforced.  These  opinions  are  based,  for  the  most 
part,  on  the  theory  that  drinkers  will  seek  a substitute  for  alcohol 
and  that  the  opiates  and  cocaine  will  be  found  to  be  most  satisfactory 
for  this  purpose.  This  opinion  apparently  receives  some  support 
from  investigations  made  in  some  of  the  Southern  States,  where  pro- 
hibition has  been  in  effect  for  some  years.  It  has  been  noted  that  in 
these  States  the  sales  of  narcotic  drugs  and  cocaine,  and  especially 
the  sale  of  preparations  exempt  under  section  6 of  the  Harrison  Act, 
such  as  Bateman’s  Drops,  Godfrey’s  Cordial,  and  paregoric,  have 
greatly  increased  during  this  period.  Whether  or  not  this  condition 
will  become  general  when  national  prohibition  becomes  effective  is  a 
question  which  can  not  be  answered  at  the  present  time. 

Etiology  of  addiction. — The  investigations  of  the  committee  have 
led  to  the  conclusion  that  addiction  to  the  use  of  these  habit- forming 
drugs  is  not  restricted  to  any  particular  race,  nationality,  or  class  of 
people.  Anjmne  repeatedly  taking  a narcotic  drug  over  a period  of 
30  days,  in  the  case  of  a very  susceptible  individual  for  10  days,  is 
in  grave  danger  of  becoming  an  addict.  And,  when  addiction  has 
been  established,  it  is  impossible  for  the  individual  to  discontinue  the 


23 


use  of  the  drug  without  outside  assistance.  These  statements  are 
supported  by  the  opinion  of  medical  men  who  were  consulted  on  the 
matter  and  by  reports  which  have  appeared  in  medical  journals. 
The  more  important  findings  of  the  committee  w^hich  have  a bearing 
on  the  subject  of  the  etiology  of  drug  addiction  are  as  follows ; 

Data  assembled  b}'^  the  committee  show  that  the  habit  of  using 
opiates  or  cocaine  is  acquired  through  association  with  addicts, 
through  the  physician,  and  through  self-medication  with  these  drugs, 
or  patent  or  proprietary  preparations  containing  the  same.  The  first 
two  ways  in  which  addiction  is  acquired  are  of  about  equal  importance 
at  the  present  time,  the  last  being  of  lesser  importance  in  the  light  of 
the  replies  received  to  the  questionnaires  sent  out. 

With  respect  to  this  phase  of  the  subject,  the  committee  finds  that 
addicts  may  be  divided  into  two  classes,  namely,  the  class  composed 
principally  of  addicts  of  the  tindemmrld  and  the  class  which  is  made 
up  almost  entirely  of  addicts  in  good  social  standing. 

The  addict  of  the  underworld,  in  a large  majority  of  cases,  ac- 
quii-es  the  habit  of  using  these  drugs  through  his  or  her  associates. 
This  is  pi’obably  due  to  the  fact  that  addicts  of  this  class  make  u.se  of 
heroin  and  cocaine  most  frequently,  these  drugs  being  employed  as  a 
snuff.  It  is  therefore  an  easy  matter  to  treat  a companion  to  a sniff 
of  the  “ dope.”  In  addition,  these  drugs  are  made  use  of  by  “ white 
slavers  ” in  securing  and  holding  their  prey,  and  by  prostitutes  in 
entertaining  their  callers. 

"With  respect  to  the  addict  of  good  social  standing,  the  e^ddeuce 
obtained  by  tiie  committee  points  to  the  physician  as  the  agent 
through  whom  the  habit  is  acquired  in  the  majority  of  cases.  Some, 
however,  become  addicted  to  the  use  of  the.s8  dnxgs  through  self- 
medication,  while  a few  first  indulge  as  a social  diversion. 

The  drugs  used  by  addicts  in  order  of  their  frequency,  as  shown  in 
the  replies  to  ail  forms  of  questionnaires  sent  out  by  the  committee, 
are  as  follows:  Morphine,  heroin,  opium  (all  forms)  and  cocaine. 
Codeine,  laudanuni,  and  paregoric  are  reported  as  being  used  in  about 
equal  amounts,  but  to  a lesser  extent.  In  recent  years  the  use  of  heroin 
has  greatly  increased,  and  in  some  communities  it  is  at  present  used 
more  extensively  than  any  of  the  other  drugs.  This  is  believed  to  be 
due  to  the  ease  v/ith  which  it  can  be  taken,  it  being  usually  emplo}'^ed 
as  a snuff,  and  to  the  fact  that  the  habit  is  acquired  by  association  in 
a large,  majority  of  cases.  It  is  at  present  legarded  by  manj'^  as  the 
most  dangerous  of  these  drugs  from  the  standpoint  of  habit  forma- 
tion and  the  creation  of  new  addicts. 

- The  committee  has  obtained  no  information  to  show  that  there  is 
any  relationship  between  the  age  of  indi^'iduals  and  susceptibility  to 
addiction.  The  range  of  ages  of  addicts  was  reported  as  12  to  75 
years.  The  large  majority  of  addicts  of  all  ages  was  reported  as 


24 


using  morphine  or  opium  or  its  preparations.  Many  of  the  older  ad- 
dicts were  reported  to  have  acquired  the  habit  when  still  in  their  teens. 
Most  of  the  heroin  addicts  are  comparatively  young,  a large  portion 
of  them  being  boys  and  girls  under  the  age  of  20.  This  is  also  true  of 
cocaine  addicts,  many  of  them,  according  to  reports,  being  mere 
children. 

The  statistics  compiled  by  the  committee  show  that  the  greater 
part  of  the  addicts  in  this  country  are  American  born.  It  is  a rare 
occurence  to  find  an  addict  among  the  immigrants  on  their  arrival  in 
this  country,  although  some  of  them  become  addicted  to  the  use  of 
these  drugs  after  taking  up  their  abode  in  this  country.  Of  course 
this  statement  does  not  apply  to  the  Chinese  and  certain  other 
nationalities  of  the  Oi’ient.  In  the  replies  received  to  questionnaires 
sent  out  by  the  committee,  practically  every  nationality  was  reported. 
These  replies,  however,  did  not  show  any  relationship  between  na- 
tionality and  extent  of  addiction  among  the  foreign  born. 

Contrary  to  general  opinion  the  committee  finds  that  drug  addic- 
tion is  not  more  prevalent  among  females  than  males.  Eeports 
obtained  from  some  i^arts  of  the  country  show  that  the  females  out- 
numbered the  males,  while  in  other  sections,  officials  rej)orted  a pre- 
ponderance of  males.  Taking  all  factors  into  consideration,  it 
appears  that  ding  addiction  is  about  equally  prevalent  in  both  sexes. 

The  information  collected  by  the  committee  does  not  show  any 
direct  relationship  between  any  specific  occupation  and  drug  addic- 
tion. Addicts  are  found  engaged  in  all  lines  of  work.  It  has  been 
stated  that  the  percentages  of  addicts  is  greatest  among  peoiole 
engaged  in  the  practice  of  medicine  or  closely  related  occupations, 
such  as  the  practice  of  pharmacy,  dentistry,  and  nursing.  The  com- 
mittee was,  however,  unable  to  confirm  this  report.  From  the  sta- 
tistics collected  it  appears,  however,  that  a large  portion  of  the 
addicts  are  not  engaged  in  occupations  which  call  for  hard  labor,  and 
that  many  are  not  employed  at  all  or  work  intermittently.  This  is 
especially  true  of  cocaine  and  heroin  habitues. 

E-jfect  of  addiction  on  health. — The  committee  is  forced  to  conclude 
from  its  investigations  that  the  habit-forming  drugs  herein  men- 
tioned produce  a marked  phj^^sical  and  mental  deterioration  in  indi- 
viduals addicted  to  their  use. 

The  constant  use  of  narcotics,  such  as  opium,  its  preparations  and 
alkaloids  produces  a condition  in  the  human  body  which  is  beginning 
to  be  looked  upon  by  physicians  as  a disease.  This  diseased  condition 
requires  the  repeated  administration  of  the  drug  of  addiction  to  keep 
the  body  functioning  normally  or  the  institution  of  medical  treat- 
ment. The  mere  withdrawal  of  the  drug  induces  such  fundamental 
disorganization  and  such  painful  disturbances  that  addicts  are  driven 
to  any  extreme  to  procure  more  of  the  drug  with  which  to  allay  their 


25 


suffering.  For  years,  individuals  addicted  to  the  use  of  opiates  may 
apj)ear  quite  normal  to  the  ordinary  observer,  but  close  attention  will 
usually  reveal  signs  of  diseased  conditions  as  evidenced  by  variability 
of  moods,  waxy  complexion,  emaciation,  diseased  condition  of  the 
I'espiratory  organs,  heart,  and  kidneys.  Continued  addiction  brings 
about  sexual  sterility  and  thus  reduces  the  birthrate  among  this 
class.  If  impregnation  occurs  during  a period  of  abstinence  from  the 
dnig,  and  the  mother  later  begins  using  the  drug  again,  the  child 
when  born  becomes  addicted  through  the  mother's  milk. 

The  effect  of  cocaine  is  somewhat  different.  While  it  causes  a more 
rapid  physical  and  mental  deterioration  than  the  opiates,  the  changes 
produced  are  not  as  profound,  and  the  drug  may  be  completely  with- 
drawn without  danger  of  serious  results  following.  In  addition  to  the 
systemic  effects  of  the  use  of  cocaine,  individuals  addicted  to  this 
drug  often  show  a perforation  of  the  nasal  septum  as  a result  of  the 
local  action  of  the  ding  when  it  is  used  as  a snuff'.  This  condition  has 
also  been  observed  in  heroin  addicts,  this  drug  being  usually  taken  in 
the  same  manner.  The  committee  also  finds  that  insanity  is  not  in- 
frequently a result  of  the  use  of  cocaine  in  the  case  of  addicts. 

In  cases  where  any  of  these  drugs  are  taken  hypodermically,  there 
is  freqently  noticed  abscesses,  scarring,  and  disfiguration  of  those 
parts  of  the  body  in  which  the  needle  was  inserted.  In  general  the 
physical  deterioration  which  results  from  the  continued  use  of  any  of 
these  drugs  brings  about  a diminution  in  the  power  of  resistance  so 
that  the  addict  falls  an  easy  prey  to  some  other  ailment,  and  thus 
very  seldom  reaches  old  age. 

Effeet  of  addiction  mx  morale. — From  information  in  the  hands  of 
the  committee,  it  is  concluded  that,  while  drug  addicts  may  appear  to 
be  normal  to  the  casual  observer,  they  are  usually  indi\dduals  weak 
in  character  and  will,  and  laclring  in  moral  sen.se. 

The  opium  or  morphine  addict  is  not  always  a hopeless  liar,  a moral 
wreck,  or  a creature  sunk  in  vice  and  lost  to  all  sense  of  decency  and 
honor,  but  may  often  be  an  upright  individual  except  under  circum- 
stances jvhich  involve  his  affliction,  or  the  procuring  of  the  drug  of 
addiction.  He  will  usually  lie  as  to  the  dose  nece,9sary  to  sustain  a 
moderately  comfortable  existence,  and  he  will  stoop  to  any  subterfuge 
and  even  to  theft  to  achieve  relief  from  the  bodily  agonies  ex- 
perienced as  a result  of  the  withdrawal  of  the  drug.  There  are  many 
instances  of  cases  where  victims  of  this  disease  v^ere  among  the  people 
of  the  highest  qualities  morally  and  intellectuallj',  and  of  the  greatest 
value  to  their  coinmnunities,  who,  when  driven  by  sudden  deprivation 
of  their  drug,  have  been  led  to  commit  felony  or  violence  to  relieve 
their  misery. 

Addiction  to  the  use  of  cocaine  produces  a much  more  rapid  de- 
terioration of  mental  powers  and  moral  sense.  It  is  this  class  of 


26 


addicts  that  most  frequently  commit  moral  wrongs  and  crimes  of 
violence. 

Among  the  addicts  of  the  underworld,  practically  all  show  a low 
mentality,  a lack  of  decency  and  honor.  This  condition,  lioweA^er,  is 
not  entirely  due  to  the  effect  of  these  drugs  as  might  be  inferred,  but 
is  largely  the  result  of  degeneracy  due  to  environment  and  association. 

Relation  of  drug  addiction  to  crime. — The  committee  finds  that  the 
drug  habit  has  some  bearing  on  the  question  of  crime.  Eeports  from 
officials  of  prisons  and  reformatories  show  that  a number  of  the  in- 
mates are  drug  addicts.  In  1916,  the  addicts  in  the  city  prison 
(Tombs)  at  Manhattan  constituted  5 per  cent  of  the  total  number  of 
prisoners.  There  is,  howeA'er,  a great  A'ariety  of  evidence  on  this 
subject  which  has  not  yet  been  made  clear. 

The  users  of  opium  and  morphine  are  seldom  seen  in  the  courts  for 
brutal  crimes.  The  offenses  committed  by  them  in  the  order  of  their 
frequenc}^  as  indicated  by  replies  to  questionnaires  sent  out  by  the 
committee  are  larceny,  burglary,  A’agrancy,  forgery,  assault,  and 
violation  of  the  drug  laws.  They  are  frequently  aiders  or  abettors  of 
crimes,  but  less  commonly  the  leading  actors  in  criminal  conduct. 

In  cases  where  addicts  haA^e  committed  violent  crimes,  it  is  re^^orted 
that  they  Avere  users  of  cocaine  or  heroin.  These  are  also  the  drugs 
, which  are  most  frequently  used  b}^  prostitutes  and  those  engaged  in 
' the  “ AA'hite-slaA'e  traffic.”  These  drugs  appear,  therefore,  to  be  the 
■ most  obnoxious. 

Economic  aspect  of  drug  addiction.— VilrAo,  the  committee  has  been 
unable  to  secure  sufficient  data  to  enable  it  to  formulate  a statement 
which  will  convey  exact  knoAvledge  of  the  economic  phase  of  drug 
addiction,  it  is  belieA^ed  some  idea  of  the  economic  loss  to  the  country 
sustained  through  addiction  maj"  be  gained  from  the  cost  of  the  drugs 
used  by  addicts  and  the  loss  through  unemployment  of  those  addicted. 
It  has  been  computed  by  the  State  food  and  dnig  commissioner  of 
one  of  the  States  having  stringent  regulatory  laAvs  that  the  aA’erage 
annual  ex])enditure  for  an  addict  to  satisfy  his  addiction  amounts 
to  $61.18.  Upon  this  basis  of  cost  of  drugs  alone,  the  addicts  of  this 
country  annually  pay  oA'er  $61,000,000  for  the  satisfaction  of 
addiction. 

The  figures  obtained  by  the  committee  vary  as  to  the  aA^erage  per- 
centage of  addicts  regularly  employed,  employed  part  of  the  time,  and 
not  employed  at  all.  But  it  is  concluded  from  a careful  analysis  of 
these  figures,  as  Avell  as  those  obtained  by  other  investigators  who 
haA’e  made  a study  of  this  problem,  that  at  least  25  per  cent  of  the 
addicts  are  not  steadily  employed  in  gainful  occupations.  This 
Avould  represent  at  least  250,000  unemployed  addicts  in  the  United 
States.  At  a conservative  estimate  this  Avould  represent  the  loss  in 
Avages  of  $150,000,000  annually.  These  figures,  hoAvevei*,  do  not  in- 


27 


dude  the  cost  of  drug  addiction  to  individuals  as  a result  of  loss 
through  theft  and  burglary,  nor  the  cost  to  the  States  and  municipali- 
ties in  the  suppression  and  punishment  of  crime,  and  the  care  and 
treatment  of  those  Avho  eventually  become  a charge  upon  the  com- 
munity. 

CONCLTJSrONS  AND  RECOIMMENDATIOXS. 

From  the  data  obtained  the  committee  is  convinced  that  there  is  a 
nation-wide  use  of  narcotic  drugs  for  other  than  legitimate  medical 
needs,  and  that  such  use  for  the  satisfaction  of  addiction  has  mate- 
rially increased  in  certain  sections  of  the  country  despite  the  vigorous 
efforts  exerted  in  the  past  four  ye^irs  in  the  enforcement  of  the  Fed- 
eral antinarcotic  law,  and  in  the  enforcement  of  the  laws  of  the  States 
and  municipalities  which  have  enacted  such  for  the  control  of  habit- 
forming drugs.  Furthermore,  it  is  apparent  from  the  replies  to 
questionnaires  sent  out  that  there  has  been  no  definite  or  concerted 
action  on  the  part  of  the  majority  of  the  State  and  municipal  govern- 
ments to  suppress  the  illicit  traffic  and  use  of  habit-forming  drugs, 
and  that  there  has  been  but  little,  if  any,  attempt  made  to  secure 
accurate  information  concerning  the  problem  of  drug  addiction  as  a 
basis  for  the  enactment  of  proper  legislation  and  i-egulation.  The 
replies  to  the  questionnaires  sent  out  to  State,  county,  and  municipal 
officials  show  that  a great  majority  of  these  officials  kept  no  records 
and  therefore  had  no  information  upon  the  subject.  This  condition 
is  believed  to  be  due  principally  to  a lack  of  knowledge  of  the  serious- 
ness of  the  situation.  In  many  cases  it  is  no  doubt  partly  due  to  the 
more  or  less  general  acceptance  of  the  old  theory  that  drug  addiction 
is  a vice,  or  depraved  taste,  and  not  a disease,  as  held  by  modern  inves- 
tigators. This  attitude  has  had  the  effect  of  holding  these  unfortu- 
nate creatures  up  to  public  scorn,  and  thereby  lessening  any  interest 
in  their  welfare.  Eecords  having  a bearing  on  any  and  all  phases 
of  drug  addiction  are  of  sufficient  importance  to  Avarrant  immediate 
action  for  the  purpose  of  remedying  these  conditions. 

Inasmuch  as  the  Harrison  antinarcotic  law  has  recently  been 
amended  by  Congress  in  accordance  Avith  the  suggestions  made  by  the 
committee  in  its  preliminary  report,  it  is  believed  that  the  present 
Federal  statute  confers  the  necessary  power  for  the  effective  control 
of  the  manufacture,  sale,  distribution,  and  administration  of  narcotic 
di'ugs,  and  it  is  the  opinion  of  the  committee  that  no  further  national 
legislation  is  necessary  for  this  purpose  at  this  time.  It  is,  hoAvever, 
the  opinion  of  the  com.mittee  that  there  yet  remain  several  phases 
of  the  narcotic  problem  Avhich  merit  the  consideration  of  the  Con- 
gress. 

One  of  the  more  important  of  these  is  the  question  of  the  responsi- 
bility for  the  care  and  treatment  of  addicts  Avho,  by  reason  of  the 


28 


amended  statute,  ■will  find  it  difficult,  if  not  impossible,  to  obtain  the 
supplies  of  drugs  necessary  to  maintain  their  normal  condition  due  to 
habituation.  The  enactment  of  legislation  on  the  part  of  the  National 
Government  covering  this  phase  of  the  problem,  likewise  the  passage 
of  similar  measures  by  the  States  and  municipalities,  is  deemed 
urgently  necessary. 

There  also  remains  the  international  aspect  of  the  opium  traffic 
which  should  receive  immediate  consideration.  If  this  and  the 
other  countries  represented  at  the  international  opium  convention 
are  to  effectually  control  the  traffic  in  opium  and  other  habit-forming 
drugs,  some  concerted  action  is  necessary.  It  is,  therefore,  recom- 
mended that  this  country,  through  the  State  Department,  take  up 
this  matter  with  the  other  powers  which  were  signatory  to  the  inter- 
national agreement  entered  into  at  The  Hague  in  1912  with  a view 
to  persuading  such  GoA’ernments  to  enact  the  necessary  legislation 
to  carry  out  the  terms  of  The  Hague  protocol.  Otheinvise,  the  task 
of  this  country  of  suppresing  the  illicit  traffic  in  habit- forming  drugs 
will  be  rendered  much  more  difficult. 

Pending  the  ratification  of  The  Hague  opium  com^ention  by  the 
various  powers  and  the  enactment  of  necessary  legislation  to  carry 
out  the  terms  thereof,  it  is  urgently  I’ecommended  that  the  United 
States  Government  take  up  with  the  Governments  of  the  Dominion 
of  Canada  and  Mexico  the  subject  of  more  effective  control  of  the 
manufacture  and  exportation  of  narcotic  drugs  therefrom  for  the 
purpose  of  securing  their  cooperation  with  this  Government  in  the 
suppression  of  the  smuggling  of  such  drugs  from  one  country  into 
the  other,  which  now  affords  the  principal  source  of  supply  for  the 
illicit  traffic  in  these  drugs. 

It  is  also  recommended  that  educational  campaigns  be  instituted 
in  all  parts  of  the  United  States  for  the  purpose  of  informing  the 
people  of  this  country,  including  the  medical  profession,  of  the  seri- 
ousness of  drug  addiction  and  its  extent  in  the  United  States,  and 
thereby  secure  their  aid  and  cooperation  in  its  suppression. 

It  is  also  recommended  that  both  public  and  private  medical  or- 
ganizations which  have  research  facilities  be  requested  to  undertake 
studies  to  determine  the  nature  of  drug  addiction  with  the  view  of 
improving  the  present  forms  of  treatment  or  evolving  some  new  and 
more  efficient  method  of  handling  these  patients.  The  latter  state- 
ment is  made  in  view  of  the  fact  that  at  the  present  time  there  are 
numerous  forms  of  treatment  for  drug  addiction,  none  of  which 
appear  to  have  been  given  a thorough  trial  b5'^  the  medical  profession, 
as  a whole,  or  to  have  receiA’^ed  the  unqualified  support  of  those 
members  of  the  profession  who  have  had  no  financial  interest  in  the 
matter. 


29 


It  is  the  opinion  of  the  committee,  based  on  the  results  of  its  inves- 
tigations, that  the  medical  need  for  heroin,  a derivative  of  morphine, 
is  negligible  compared  with  the  evil  effects  of  the  use  of  this  alkaloid, 
and  that  it  can  easily  be  replaced  by  one  of  the  other  alkaloids  of 
opium  with  the  same  therapeutic  results,  and  witli  less  danger  of 
creating  habituation.  Therefore,  consideration  .sliould  be  given  the 
subject  of  absolutely  prohibiting  the  manufactm'e,  sale,  distribution, 
or  administration  of  this  most  dangerous  drug  by  the  States  and 
municipalities. 

Eespectfully, 

•Hekry  T.  Rainev, 
Meraoer.  of  Congress^  Chainnan, 


Reid  Hunt, 


Professor  of  Phannacologg^  II iw card  University. 

B.  C.  Keith, 

Deputy  Commissioner  of  Internal  Revenue. 

A.  G.  Du  Mez, 

United  States  Public  Ueulth  Service.,  Secretary. 
B.  R.  Rhees,  M.  D., 

Clerk  to  C ommittee. 


o 


